North American Spine Society Journal最新文献

{"title":"8. Intravenous infusion of auto serum-expanded autologous mesenchymal stem cells in chronic spinal cord injury patients: 7 case series","authors":"","doi":"10.1016/j.xnsj.2024.100346","DOIUrl":"10.1016/j.xnsj.2024.100346","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>In the chronic phase, functional recovery of spinal cord injury (SCI) without any therapeutic intervention is highly limited. Therefore, new treatments are desired to enhance residual function, with the important objection of increasing the quality of life in chronic SCI patients. Intravenous infusion of auto serum-expanded autologous bone marrow-derived mesenchymal stem cells (MSCs) for acute SCI patients has shown the safety and potential therapeutic efficacy of this approach. However, the clinical use for the chronic phase of SCI has not been studied.</p></div><div><h3>PURPOSE</h3><p>This study explores safety, feasibility and potential improvement in functional status after intravenous infusion of MSCs in chronic severe SCI patients.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>We report a case series of 7 chronic SCI patients with AIS grades C and D who received autoserum-expanded autologous MSCs. Statistical analyses were performed using JMP 11.1 for Windows (SAS Institute Inc.). The differences between status prior to MSC infusion and 6 months postinfusion, for both ISCSCI-92 and SCIM-III among the groups were analyzed using one-way analysis of variance followed by Bonferroni's post hoc tests. Data are expressed as mean ± standard error of the mean. Differences were considered statistically significant at p &lt; 0.05.</p></div><div><h3>PATIENT SAMPLE</h3><p>The patients included 5 men and 2 women who ranged 20 to 52 years old (mean 39.6 years old). After careful examination, 7 patients with chronic SCI were included in this study based on the following inclusion and exclusion criteria. Inclusion criteria: (1) 180 days or more after onset of SCI, (2) <strong>a</strong>ge at least 18 years old, (3) rehabilitation can be performed more than 4 units per day, (4) the written informed consent obtained as much as possible from subjects (<strong>i</strong>f the subject does not have ability to write, the written informed consent obtained from legal representative alone).</p></div><div><h3>OUTCOME MEASURES</h3><p>Each participant's status on SCI scales including American Spinal Injury Association (ASIA) impairment scale, International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI-92), and Spinal Cord Independence Measure-III (SCIM-III) was assessed from 0 to 14 days prior to MSC infusion, and at 90 (± 14) and 180 (± 14) days post-MSC infusion, by at least 2 board-certified orthopedic surgeons who were not blinded. The primary outcome measure of this clinical study was the proportion of cases whose ASIA scale improved one point or more at 180 ± 14 days post-MSC infusion compared to the functional status just prior to MSC infusion (0-14 days). All patients were monitored closely during and within 24 h of the autologous human MSC injections. Oxygen saturation, body temperature, electrocardiogram, blood pressure, pulse and respiratory rate were carefully monitored before and after injection.","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000398/pdfft?md5=382142ddea8145cd320e79a6c37a887e&pid=1-s2.0-S2666548424000398-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P8. A MSSIC Study Reveals Non-Modifiable Risk Factors Were Associated with Post-Operative Hematoma following ACDF","authors":"","doi":"10.1016/j.xnsj.2024.100412","DOIUrl":"10.1016/j.xnsj.2024.100412","url":null,"abstract":"<div><p>This abstract has been previously published as part of the Cervical Research Society 51^st Annual Meeting proceedings. For full access to the abstract, please visit the following URL: <span><span>https://scholarlyworks.beaumont.org/orthopaedic_surgery_posters/16/</span><svg><path></path></svg></span></p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001057/pdfft?md5=c872a1613d60f19c612b946e5ac300c4&pid=1-s2.0-S2666548424001057-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P28. Deep learning-based detection of lumbar spinal canal stenosis using convolutional neural networks","authors":"","doi":"10.1016/j.xnsj.2024.100432","DOIUrl":"10.1016/j.xnsj.2024.100432","url":null,"abstract":"<div><h3>Background Context</h3><p>Lumbar spinal canal stenosis (LSCS) is the most common spinal degenerative disease in elderly people and usually first seen by primary care physicians or orthopedic surgeons who are not spine surgery specialists. Magnetic resonance imaging (MRI) is useful in the diagnosis of LSCS, but the equipment is often not available or difficult to read. LCSC patients with progressive neurologic deficits have difficulty with recovery if surgical treatment is delayed. So, early diagnosis and determination of appropriate surgical indications are crucial in the treatment of LCSC. Convolutional neural networks (CNNs), a type of deep learning, offers significant advantages for image recognition and classification, and work well with radiographs, which can be easily taken at any facility.</p></div><div><h3>Purpose</h3><p>Our purpose was to develop an algorithm to diagnose the presence or absence of LSCS requiring surgery from plain radiographs using CNNs.</p></div><div><h3>Study Design/Setting</h3><p>This study is a cross-sectional study.</p></div><div><h3>Patient Sample</h3><p>One hundred patients who underwent the surgery for LSCS including degenerative spondylolisthesis from January 2022 to May 2022 at a single institution were enrolled.</p></div><div><h3>Outcome Measures</h3><p>In annotation 1, the area under the curve (AUC) computed from the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated. In annotation 2, correlation coefficients were used.</p></div><div><h3>Methods</h3><p>Four intervertebral levels from L1/2 to L4/5 were extracted as region of interest from lateral plain lumbar spine radiographs and totally 400 images were obtained. Based on the date of surgery, the 300 images derived from the first 75 cases were used for internal validation and 100 images from the second 25 cases for external validation. In annotation 1, binary classification of operative and nonoperative levels was used, and in annotation 2, the spinal canal area rate was calculated by dividing each disc level area measured on the MRI axial image by L1/2 level area. For internal validation, 300 images were divided into each 5 datasets on per-patient basis and 5-fold cross-validation was performed. Five trained models were registered in the external validation prediction performance. Grad-CAM was used to visualize area with the high features extracted by CNNs.</p></div><div><h3>Results</h3><p>In internal validation, the range of AUC and accuracy were 0.80 to 0.96 and 75% to 93% for the annotation 1 and correlation coefficients of 0.60 to 0.72 (All p&lt;.01) for the annotation 2. In external validation, the AUC and accuracy were 0.93 and 86% in annotation 1, and correlation coefficient was 0.69 in annotation 2 using 5 trained CNN models. Grad-CAM showed high feature density","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001252/pdfft?md5=a318965fbd961106a972e510c95fa677&pid=1-s2.0-S2666548424001252-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"18. Reason for revision surgery after cervical disc arthroplasty based on medical device reports maintained by the United States Food and Drug Administration","authors":"","doi":"10.1016/j.xnsj.2024.100356","DOIUrl":"10.1016/j.xnsj.2024.100356","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Cervical disc arthroplasty (CDA) was established in the last two decades as a motion-sparing alternative to anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease, achieving comparable patient-reported and clinical outcomes. Despite showing this outcome difference for various CDA models compared to ACDF, few studies have compared CDA models to one another. One study investigated the range of complications for the different CDAs based on reports from the Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database until 2020, showing variability for each device. However, this study has not reported a detailed look at reported revision cases. To date, literature on complications associated with revision surgery for CDA is limited, mainly comparing CDA to fusion instead of comparing different CDA models to one another.</p></div><div><h3>PURPOSE</h3><p>To analyze revision cases due to complications related to CDA reported to the MAUDE database.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective database review.</p></div><div><h3>PATIENT SAMPLE</h3><p>Nationwide database of reported revision cases related to CDA.</p></div><div><h3>OUTCOME MEASURES</h3><p>Factors associated with revision for CDA.</p></div><div><h3>METHODS</h3><p>The MAUDE database was queried for data from January 2005 to September 2023. All the reported complication entries for the nine FDA-approved CDA devices were analyzed. The full-text entries of all complications were analyzed, reported, and grouped depending on the revision surgery performed. For each revision case, the device used, the associated complication, the time until revision, and the type of revision surgery were collected. Those reports with insufficient information or were reported over social media were excluded.</p></div><div><h3>RESULTS</h3><p>In summary, 1,347 entries were analyzed from the MAUDE database, with the highest number of reports made to the database in 2018 (218). A total of 678 cases reported revision surgery for nine different CDA models: Mobi-C (239), M6 (167), Prodisc-C (88), Prestige (60), PCM (44), Bryan (35), Secure (23), Simplify (21) and Discover (1). The top three complications associated with CDA revision were implant migration (23.5%), neck pain (15.5%), and heterotopic ossification (6.6%). The top complication per device was migration for Mobi-C (26.4%), Prodisc-C (21.3%), Prestige (24.6%), PCM (84.1%), Bryan (48.6%), Secure (30.4%) and Discover (100%). For M6 the number one cause of revision was evenly split between osteolysis (18.6%) and neck pain (18.6%), while for Simplify, it was neck pain (23.8%). Of the reports that included the type of revision surgery, 283 (54.7%) were recorded as conversion to fusion.</p></div><div><h3>CONCLUSIONS</h3><p>The MAUDE database highlights complications related to revision cases for CDA, which may not receive sufficient emphasis in existing published studi","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000490/pdfft?md5=0285d8ea43b5d60faa276998315508cf&pid=1-s2.0-S2666548424000490-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P6. Mechanical stress change of intervertebral disc in rod fracture model after posterior spinal fusion: finite element analysis","authors":"","doi":"10.1016/j.xnsj.2024.100410","DOIUrl":"10.1016/j.xnsj.2024.100410","url":null,"abstract":"<div><h3>Background Context</h3><p>Rod fracture is the one of postoperative complications in posterior spinal fusion surgery for adult spinal deformity and its prevalence has been reported as 6.8-38.8%. The reoperation rate of rod fracture after spinal fusion is reported to be 41.2-87%, which is higher in patients with bilateral rod fracture (75-91%) than those with unilateral rod fracture (21-43%). Despite high reoperation rate in patients with rod fracture, especially bilateral rod fracture, the pathological mechanisms including mechanical stress change of intervertebral disc in patients with rod fracture have not been well-studied.</p></div><div><h3>Purpose</h3><p>To clarify mechanical stress change of intervertebral disc in rod fracture model after posterior spinal fusion using 3D-CT finite element analysis (CT/FEA).</p></div><div><h3>Study Design/Setting</h3><p>A comparative biomechanical study.</p></div><div><h3>Patient Sample</h3><p>Seven patients ≥ 20 years old (3 males and 4 females) who underwent lumbar spinal surgery.</p></div><div><h3>Outcome Measures</h3><p>Patients’ characteristics such as age and BMI, and global spinal alignment (eg, sagittal vertical axis [SVA] and pelvic incidence minus lumbar lordosis [PI-LL]) were examined. Posterior spinal fusion models from L3 to S1 with non-rod fracture (NRF, a), unilateral rod fracture (URF, b), and bilateral rod fracture (BRF, c) at L4/5 were created using three-dimensional finite element analysis software. Forward bending loads were applied to each model, and the minimum principal stresses (MPa) of the intervertebral discs at the adjacent level (L2/3) and the rod fracture level (L4/5) were measured in each model using CT-FEA.</p></div><div><h3>Methods</h3><p>The minimum principal stresses of the intervertebral discs at L2/3 and L4/5 were compared among the NRF, URF, and BRF models using the Friedman's test and Bonferroni correction.</p></div><div><h3>Results</h3><p>The mean age was 38.0 ± 11.2 years old and BMI was 22.4 ± 2.9 kg/m². The mean SVA was 30.4 ± 60.9 mm and the PI-LL was 6.7 ± 12.5°. No significant differences in the minimum principal stresses at L2/3 level among three models were observed (NRF, 11.0 MPa; URF, 7.5 MPa; BRF, 6.7 MPa, p=.651. At L4/5 level, no significant differences in the minimum principal stresses between the NRF and URF models or the URF and BRF models were observed; however, the minimum principal stress of the intervertebral disc at L4/5 was significantly higher in the BRF model compared to the NRF model (NRF, 0.7 MPa; BRF, 5.4 MPa, p=.001).</p></div><div><h3>Conclusions</h3><p>The mechanical stress at rod fracture level was significantly higher in bilateral rod fracture model by CT-FEA, which may contribute to the higher reoperation rate in patients with bilateral rod fracture after posterior spinal fusion surgery.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001033/pdfft?md5=d477eaf27757502d43ef25da5527c5de&pid=1-s2.0-S2666548424001033-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"22. Preoperative thoracic compensation predicts pelvic tilt response and proximal junctional kyphosis in adult spinal deformity surgery: a retrospective study","authors":"","doi":"10.1016/j.xnsj.2024.100360","DOIUrl":"10.1016/j.xnsj.2024.100360","url":null,"abstract":"<div><p>This abstract was previously published in the 2023 Spineweek proceedings. For access to the original publication, please visit the following URL: <span><span>https://www.sosort.org/resources/Documents/Spineweek_2023_oral_abstracts_final-1.pdf</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000532/pdfft?md5=a7e9d1bb321ebb340c58101e1876686b&pid=1-s2.0-S2666548424000532-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1. Geriatric nutritional risk index can predict 90-day mortality in patients with osteoporotic vertebral fractures","authors":"","doi":"10.1016/j.xnsj.2024.100339","DOIUrl":"10.1016/j.xnsj.2024.100339","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Fragility fractures are common in elderly patients and are associated with high mortality and functional disability. The geriatric nutritional risk index (GNRI) is an objective nutritional status assessment tool to predict mortality risk in hospitalized patients. However, whether the GNRI reflects short-term mortality in fragility fracture patients is unclear. This study aimed to examine the nutritional status assessed by the GNRI in patients with fragility fractures and identify cut-off scores that predict mortality risk.</p></div><div><h3>PURPOSE</h3><p>N/A</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>N/A</p></div><div><h3>PATIENT SAMPLE</h3><p>N/A</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>Elderly fragility fracture patients in our hospital from 2021 to 2023 were retrospectively studied. A total of 56 patients (19 men and 37 women, mean age 83.2 ± 6.7 years) were included. All patients were followed up for more than 3 months. Clinical data were extracted from electronic medical records. Mortality within 90 days after admission was studied. GNRI was calculated for all patients on admission as 14.89 × serum albumin (g/dL) + 41.7 × BMI / 22. Using the recipient operating characteristic (ROC) curve, the area under the curve (AUC) that can predict mortality 90 days after admission and the optimal cut-off scores were calculated.</p></div><div><h3>RESULTS</h3><p>The mean GNRI was 97.2 ± 9.2 (76.6-114.7). Three (5.2%) deaths occurred in the cohort; the ROC-AUC value was 0.85, and the cut-off GNRI was 95.6. Sensitivity and specificity were 100% and 64.2%, respectively.</p></div><div><h3>CONCLUSIONS</h3><p>Our results show that nutritional status assessment using GNRI can help predict mortality within 90 days in elderly fragility fracture patients; GNRI can be considered a simple tool to predict mortality risk in fragility fracture patients. In addition, early detection of low nutritional status may improve nutritional status before fracture, reducing mortality risk.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000325/pdfft?md5=0eff3d0d4d7557c1f47fcabdc5379459&pid=1-s2.0-S2666548424000325-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P3. 4.5 mm Molybdenum-Rhenium (MoRe®) rods in complex adult spine surgery without rod fractures: 2-year follow-up multicenter retrospective review","authors":"","doi":"10.1016/j.xnsj.2024.100407","DOIUrl":"10.1016/j.xnsj.2024.100407","url":null,"abstract":"<div><p>This abstract has been previously published as part of the 2024 International Meeting on Advanced Spine Techniques proceedings. For access to the original publication, please visit the following URL: <span><span>https://www.srs.org/Files/IMAST/IMAST2024/Documents/IMAST24-Final-v6-4web.pdf</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001008/pdfft?md5=cdbd81ff0724107c6a07266e7d798c04&pid=1-s2.0-S2666548424001008-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P9. Analysis of risk factors of adjacent vertebral fracture after balloon kyphoplasty including trunk muscles","authors":"","doi":"10.1016/j.xnsj.2024.100413","DOIUrl":"10.1016/j.xnsj.2024.100413","url":null,"abstract":"<div><h3>Background Context</h3><p>Balloon kyphoplasty (BKP) is a low invasive and effective treatment for pseudarthrosis in the vertebral body after osteoporotic vertebral fracture. However, a major problem in many cases is adjacent vertebral fracture (AVF). The cause of AVF is still unclear.</p></div><div><h3>Purpose</h3><p>The aim of this study was to analyze the risk factors of AVF after BKP.</p></div><div><h3>Study Design/Setting</h3><p>Retrospective study.</p></div><div><h3>Patient Sample</h3><p>Eighty-seven patients had BKP for pseudarthrosis after vertebral body fracture in our institution from 2015 May to 2023 June. We retrospectively investigated 68 patients (23 males, 45 females) who had only single-level BKP for levels &gt;L2 and were followed up for &gt;6 months after surgery. We excluded patients who had BKP with other surgery and BKP of &lt;L3. The average age at surgery was 77.5 years old, and the average follow-up period was 13.4 months.</p></div><div><h3>Outcome Measures</h3><p>Data were analyzed using the Mann-Whitney U test.</p></div><div><h3>Methods</h3><p>We divided the patients into two groups: Group A (n = 23) had AVF after BKP during follow-up, and Group B (n = 45) had no additional AVF after BKP. We compared the risk factors between groups. Before BKP, we investigated duration from onset to BKP, body mass index (BMI), young adult mean (YAM) in the lumbar spine and femoral neck. As preoperative radiographic findings, we investigated the area of intra-vertebral cleft, the intravertebral body instability and the height of vertebral body. The area ratio of the major psoas muscle/vertebral body, back muscles (multifidus muscle, longissimus muscle, iliocostal muscle)/vertebral body was investigated. The area ratios were measured at the craniad L4 vertebral body end-plate level in axial CT images and regarded the ratio as the amount of each muscle. The area of fat and muscle in the major psoas and back muscles were investigated to clarify the quality of the trunk muscle. The area in which Hounsfield Unit was -100 to -50 and 30 to 120 were regarded as the area of fat and muscle in the major psoas and back muscles at L4 vertebral body end-plate level in axial CT images. The amount of PMMA used for BKP and difference of vertebral body height after BKP were also investigated.</p></div><div><h3>Results</h3><p>Significant difference was observed only in the area ratio of the back muscles/L4 vertebral body (average: 1.40 in Group A and 1.95 in Group B; p&lt;.01). However, other factors, including the area ratio of the major psoas muscle /L4 vertebral body, have no significant difference between groups. In Group A, the area of fat in major psoas and back muscles were increased compared with Group B, and two patients who had AVF despite the higher area ratio of back muscles had low muscle quality. In Group B, 6 patients who had no additional AVF despite the lower area ratio of muscle had high muscle quality.</p></div><div><h3>CONCLUSION","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001069/pdfft?md5=e0532f01c742020a8c148bec9d477792&pid=1-s2.0-S2666548424001069-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"64. Comparison of the effects of topical and intravenous administration of tranexamic acid on postoperative blood loss in single-level posterior lumbar interbody fusion","authors":"","doi":"10.1016/j.xnsj.2024.100402","DOIUrl":"10.1016/j.xnsj.2024.100402","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Tranexamic acid (TXA), a synthetic antifibrinolytic drug, competitively blocks the lysine-binding sites of plasminogen, plasmin, and tissue plasminogen activator, thus reducing bleeding. Intravenous TXA has been used to effectively reduce perioperative blood loss in spinal surgery. However, high-dose intravenous TXA may cause complications, such as seizures, deep vein thrombosis (DVT), and pulmonary embolism (PE). In contrast, topical TXA has been used to avoid the risk of such complications and has shown efficacy in reducing total blood loss in spine surgery. Topical TXA has a similar hemostatic efficacy to intravenous TXA. However, whether intravenous or topical TXA is more effective in reducing postoperative bleeding in spine surgery remains unclear.</p></div><div><h3>PURPOSE</h3><p>This study aimed to compare the efficacy and safety of topical and relatively high-dose intravenous tranexamic acid (TXA) in reducing postoperative blood loss in patients undergoing single-level posterior lumbar interbody fusion (PLIF). The same timing of administration was used for both formulations.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>This study was a nonrandomized case-control study.</p></div><div><h3>PATIENT SAMPLE</h3><p>A total of 120 patients diagnosed with single-level degenerative lumbar disease underwent single-level PLIF at our hospital between 2016 and 2023.</p></div><div><h3>OUTCOME MEASURES</h3><p>The primary outcome was postoperative blood loss, which was evaluated by measuring the output from the suction drain. Secondary outcomes included estimated total perioperative blood loss, hemoglobin (Hb) level, hemoglobin variations (Hbv), and incidence of allogeneic blood transfusion. The total perioperative blood loss was calculated using Hbv. Hbv (g/dL) were calculated from before surgery to POD4 and POD7, and the lower of the two values was included in the analyses.</p></div><div><h3>METHODS</h3><p>A total of 120 patients were retrospectively enrolled and assigned to three groups: (a) control group, which received no TXA; (b) TXA (iv) group, which received intravenous administration of a relatively high dose (2 g) of TXA immediately before wound closure; and (c) TXA (t) group, which received topical application of TXA (1 g in 100 mL saline solution) to the wound immediately before wound closure. The drain was released 20 minutes after topical or intravenous TXA administration.</p></div><div><h3>RESULTS</h3><p>A total of 120 patients were included in the study: control group, n = 60; TXA (iv) group, n = 30; and TXA (t) group, n = 30. Total postoperative blood loss was significantly lower in the TXA (t) group than in the TXA (iv) and control groups (350.8±132.6 vs 566.4±178.8 vs 704.4±225.9, respectively; both p&lt;0.01, unit: ml). Analysis of blood loss over time showed significantly less blood loss throughout the postoperative period in the TXA (t) group compared with the control group; in contrast, the TXA (i","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000957/pdfft?md5=2386191fb9cf89710b0f558d77deee6f&pid=1-s2.0-S2666548424000957-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}